Orthotics. Orthotic devices means rigid or semi-rigid supportive devices that restrict or eliminate motion of a weak or diseased body part. Orthotic braces such as for the leg, arm, neck and back, including needed changes to shoes to fit braces, braces that stabilize an injured body part and braces to treat curvature of the spine are a Covered Health Care Service. Coverage will be provided for the training necessary to use the orthotic device. Benefits are available for fitting, repairs and replacement, except as described in Section 2: Exclusions and Limitations.
Orthotics. To the extent described in Section SC - Schedule of Cost Sharing, Benefits include participation in a diabetes outpatient self-management training and education program under the supervision of a licensed health care professional with expertise in diabetes. Coverage for self-management education and education relating to diet and prescribed by a licensed Physician shall include:
1. Medically Necessary and Appropriate visits upon the diagnosis of diabetes; and
2. visits when a Physician identifies or diagnoses a significant change in the patient’s symptoms or conditions that necessitates changes in a patient’s self-management and when a new medication or therapeutic process relating to the patient’s treatment and/or management of diabetes has been identified as Medically Necessary and Appropriate by a licensed Physician
Orthotics. Coverage for prescribed orthotics will be established with a maximum limit of two hundred dollars ($200) per member or dependent per calendar year.
Orthotics. This Service Plan does not cover supportive devices for the foot, including, but not limited to, foot inserts, arch supports, heel pads and heel cups, and orthopedic/corrective shoes.
Orthotics. Pre-fabricated Orthotics requires Prior Authorization. This benefit has one or more exclusions as specified in the Exclusions Section. Outpatient Medical Services are services provided in a Hospital, outpatient facility, Practitioner’s/Provider’s office or other appropriately licensed facility. These services do not require admission to any facility. Outpatient Medical services include reasonable Hospital services provided on an ambulatory (outpatient) basis and those preventive, Medically Necessary diagnostic and treatment procedures that are prescribed by your In-network Practitioner/Provider. Refer to the Prior Authorization Section for services that require Prior Authorization. Outpatient services provided by Out-of-network Providers/Practitioners are not Covered except as provided in How the Plan Works, Eligibility and Enrollment, and Accidental Injury / Urgent Care / Emergency Health Services / Observation / Trauma Services Benefit Sections. Outpatient Medical benefits include, but are not limited to, the following services: • Chemotherapy and radiation therapy - Chemotherapy is the use of chemical agents in the treatment or control of disease. • Hypnotherapy (Limited) - Hypnotherapy is only Covered when performed by an anesthesiologist or psychiatrist, trained in the use of hypnosis when: Used within two weeks prior to surgery for chronic pain management and For chronic pain management when part of a coordinated treatment plan. • Dialysis • Diagnostic Services – Refer to the Diagnostic Services Section • Medical Drugs (Medications obtained through the medical benefit).
Orthotics. Some Pre-fabricated Orthotics require Prior Authorization.
Orthotics. Pre-fabricated Orthotics requires Prior Authorization. This benefit has one or more exclusions as specified in the Exclusions Section. Outpatient Medical Services are services provided in a Hospital, outpatient facility, Practitioner’s/Provider’s office or other appropriately licensed facility. These services do not require admission to any facility. Outpatient Medical services include reasonable Hospital services provided on an ambulatory (outpatient) basis and those preventive, Medically Necessary diagnostic and treatment procedures that are prescribed by your In-network Practitioner/Provider. Refer to the Prior Authorization Section for services that require Prior Authorization. Outpatient services provided by Out-of-network (outside of the 5-county area) Providers/Practitioners are not Covered except as provided in How the Plan Works, Eligibility and Enrollment, and Accidental Injury / Urgent Care / Emergency Health Services / Observation / Trauma Services Benefit Sections. Outpatient Medical benefits include, but are not limited to, the following services: • Chemotherapy and radiation therapy - Chemotherapy is the use of chemical agents in the treatment or control of disease. • Hypnotherapy (Limited) - Hypnotherapy is only Covered when performed by an anesthesiologist or psychiatrist, trained in the use of hypnosis when: Used within two weeks prior to surgery for chronic pain management and For chronic pain management when part of a coordinated treatment plan. • Dialysis
Orthotics. Treatments or diagnosis for obesity, including diet control, exercise and weight reductions, except for morbid obesity. This exclusion does not apply to any obesity or disease management program agreed to by the parties.
Orthotics. This benefit covers the fitting and purchase of braces, splints, orthopedic appliances, and Orthotic supplies or apparatuses used to support, align or correct deformities or to improve the function of moving parts of the body. This benefit does not cover off-the shelf shoe inserts or orthopedic shoes. Pediatric vision services, including professional fees, supplies and materials, are covered for children under the age of 19, according to the limitations described in the Schedule of Benefits. Covered services include: • Routine vision screening and eye exam, with dilation and refraction; • Prescription lenses or contacts, including polycarbonate lenses and scratch resistant coating; • Lenses may include single vision, conventional lined bifocal or trifocal, or lenticular lenses; • One pair of frames or contact lenses, in lieu of lenses and frames, once per Calendar Year; • Evaluation, xxxxxxx and follow up care; and • Low vision optical devices, services, training and instruction. In addition to the applicable exclusions and plan limitations, the following services and materials are not covered by the pediatric vision benefit: • Orthoptics or vision training and any associated supplemental testing; • Plano lenses (less than ± .50 diopter power); • Two pair of glasses in lieu of bifocals; • Replacement of lenses and frames furnished under this plan which are lost or broken, except at the normal intervals when services are otherwise available; • Medical or surgical treatment of the eyes (these services are covered under your medical benefits); • Corrective vision treatments that are considered Experimental or Investigational; and • Costs for services and materials above the limitations indicated in the Schedule of Benefits.
